Crossover from ativan to diazepam making me drowsy

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From ativan 3mg nightly, I'm now at ativan 2mg nightly and 10mg Diazepam nightly. I still have to transition to a total of 10mg diazepam in the AM and 20mg diazepam nightly.

I'm sleepy especially late afternoons and this is making me scared. Will 30mg Diazepam keep me awake and functional during the day? Will this settle down in time? Nervous.

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I spoke to my psychiatrist who asked me to revert to 5mg diazepam and the rest of my ativan.

What should I expect going forward? Pls advise

[[Br...]]

Hello @[...]-  The most common complaints of those crossing to diazepam are sedation and depression.  My understanding is that both will fade once you adjust to the diazepam.  It can take a few weeks.  

Is your doctor suggesting you stop the crossover or just slowing it down?

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I was on 5mg diazepam for 6 days and then moved to 10mg since 2 days. I believe he wants me to revert and stay there for a while more. 

He did not discuss the next step.

Maybe I should give these stages more time and even try a 7.5mg dose in between? 

I know I will have more better advise on BB rather than the doc. He hasn't done a slow taper before with any patient.

Edited March 30 by [...]

[[Ka...]]

I had a similar problem  @[...] my doctor thought 3x 5mg diazepam per psychiatrist instructions would be too sedating for me - so issued me 3x 2mg. (This was a straight substitution from lorazepam).

It may be the same for you i.e. too sedating or that it’s early days at present in this crossover. Either way hopefully your clinician can rethink & offer flexibility with the dose given the sedation & monitor the process. 

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Does the slowing down make sense? Will things adjust at a lower rate? 

I really have no help or proper understanding of this. 

Should I stay for a full 2 weeks at each stage of the crossover?

[[Ka...]]

I wonder if, like me, you are sensitive to a higher dose so yes slowing down does make sense.

Like any taper a crossover needs to be mindful too & watching how it affects you and gradual. I really want this to work for you. I hope others may add comments if they have a similar experience. A 2 week plan is not fixed but is sensible to be based on how you feel. 

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Would like your inputs @[Li...] @[Pa...] @[Mi...] and anyone else who can help me.

I am concerned that if 10mg stalled me, how will i ever make it to a 30mg crossover 🤔 

[[Hu...]]

Well, Ashton proposed a crosstaper of 2.5 mg D for 0.25 Lor a week

Maybe you are going too fast nlav.

Also the active metabolite temazepam from Diazepam is a sleepingpill in itself. Getting used to that takes time. Drowsiness could be persistent. 

Edited March 30 by [Hu...]

[[kn...]]

My taper started with a cross over from both Klonopin and Ativan to 60 mgs of diazepam, 2.5 years ago and I started down from there. Feel free to  check out my taper records (up to date) and see what I've been through.  Yes, diazepam has fatigue as one of its major side effects.  I do have to lay down a couple of times a day and rest.  Symptoms have been about the same as others have reported along the benzo path.  Never had a seizure, but it has been brutal.  Given the choice of trying to taper off K or A individually, I opted to put the whole thing together and just get it over with.  The cross over was not a problem, even at 60mgs and having taking both K and A for almost 3 decades.  I'm now down to 4mg after having to up dose from 2 to 4 in early Feb of this year.  A rapid taper with large cuts resulted in an acute bout for nearly five months before I gave up and reinstated.  Don't let your prescriber  make the same mistake with you.  If he's a newbie to all of this, take your scripts and do what you feel is appropriate for yourself.  Start out small to begin with. You can chop the pills up easily for a couple of months . But, be careful. Stay at the same level and see what happens.  Everyone is different and judge success by how you feel, your own lifestyle and how effectively you're able to function.  

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So I took only 5mg of diazepam last night as part of my crossover instead of the 10mg I had attempted for two nights before this. 

I still feel an uncomfortable sense of sedation now at 2pm my time. I had a cup of tea that managed to awaken me some.

How long will it take for the 10mg effects to wear out and for me to realign to the 5mg?

I also woke up to a whole hour of anxiety this morning before I finally stepped out of bed.

Pls help. This has been so disconcerting. 

I am going to be requesting support often. I feel so low and alone in this. 

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Also, when I'm trying to adjust these doses, am I causing any significant problems to myself like kindling?

[[Ka...]]

Edited April 1 by [Ka...]

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15 years ago I started on a low dose of ativan that's now at 3mg PM. No other medication other than diazepam being introduced for the crossover. I ran into tolerance thanks to a series of antibiotics for a uti infection in Sept'23.

I don't know what the Caution means for the diazepam in the gene test either. The psychiatrist has basically sidelined it. I'm not hopeful of finding another doctor. This person  has worked for deaddiction patients at a faster rate using water titration. My husband and I informed him that I have to go much slower and he agreed to support. Liver function tests were normal just before I started D.

I intend staying on 5mg D for a week and then meeting the doctor again. But I'm still reliant on this forum for ideas on what to do next so that i can discuss with the psychiatrist. 

The 5mg helped minimize my lightheadedness and muscle twitching sxs. The 10mg had helped even more. It's just the sedation that I am unable to tolerate. And to go all the way to 30mg D? How?

Thanks @[Ka...] for remembering all that I had shared earlier. 

[[Ka...]]

It’s good to have all this info thanks @[...] 

If you plan to stay on 5mg D for a week keep a journal of how this affects you. It’s the sedation bit that needs to be listened & understood by your clinician. I would personally ask what caution means. 

You may need to go slower. It’s a gradual process. Imagine if you did a straight swop. But this should be careful & symptom led to allow your system to adjust. Sadly, the prescribers don’t fully get it & you have Ashton, link to the Maudsley Guidelines to share & maybe educate! This is your crossover. Things may settle in time which I sincerely hope so as you get further along. You don’t have any other medication to complicate things & that is an advantage. Take care 

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@[Co...], @[Pa...] advise pls

[[ns...]]

Hi nlav, sorry to hear your having such a difficult time adjusting with your cross over. 

I'm not knowledgeable enough to assist you with this but I would like to say that it's always best for me to go by how im feeling when I'm adjusting my dose. I do know its not quite the same as a crossover.

If you feel too sedated, if it were me I would adjust accordingly. Do what works for you. Lorazepam is a short life  benzo, so the effects wear off pretty quickly but remain in your system for quite awhile. Valium is a longer life benzo so as you know it will last longer and I'm sure your feeling the effects of it with the sedation your experiencing. Maybe you feel Like it's piling up on you and you over sedated.

Your objective is to taper off of lorazepam correct,? 

1mg of lorazepam is equal to 10 mg valuim. It may be you are unable to tolerate a 30mg, could be you could get stable at 5. Or even 7 mg, and then 10mg, Idk but I think I would see how I feel for a few days on the 5mg and slowly go up to 10.

Another possibility is to add 2.5mg v as you taper down the lorazepam in steps. 

As I said, if it were me I would go by how I'm feeling. If you feel the v is too much for you, don't add to it until you feel comfortable. Remember, you are cross tapering. Your trying to adjust. It can't happen all at one time ok. Make adjustments, take it slow.

Try not to focus on this and concern yourself with whether or not your doing this right or wrong. This will cause you more anxiety. 

Go by how you feel. You are going to experience discomfort no doubt, but you should adjust to the medication slowly over time it should eventually even out. 

I'm sorry I'm not giving you a perfect solution here. I can see that Katrina has explained quite well, so I would feel comfortable with that. Keep a journal, how did I feel.after I took v, the dose, what time, was I too sedated, or better today.

This will help you explain to your doctor how your doing so he can make suggestions, and it will give you a guide to follow, so I really think you have some pretty good suggestions here. 

I was going to cross over to v but decided against it because I was already so far down on the lorazapam, I didn't want to start over again. Otherwise I'd feel more confident in giving you advice. 

I hope everything works out great, I'm sure it will. 

Give it time ok

Take care 

Ns

[[Hu...]]

Edited April 5 by [Hu...]